Electronystagmography or ENG

The ENG (Electronystagmography) is a complex test, used to identify pathology with respect to the vestibular system, the cranial nerves and the brain stem. It is perhaps the most sensitive test for identifying pathology for someone with a mild brain injury. This testing is sometimes also referred to as caloric testing, however, this testing has come to refer to a battery of eye movement tests, some of which require recording of nystagmus.

This test really should be administered by a neuro-otologist or otolaryngologist as it is a complex test, used to identify pathology with respect to the vestibular system, the cranial nerves and the brain stem.

The ENG includes a combination of tests, because there is no method of directly stimulating and recording vestibular disorders, without indirect measures. The ENG commonly includes the following testing:

• Tests for vestibular nystagmus;
• Test for gaze-evoked nsytagmus;
• Saccades testing;
• Pursuit testing;
• Optokinectic nystagmus testing;
• Positional testing;
• Caloric testing.

These tests are most helpful if administered by a neuro-otologist or otolaryngologist, who are highly specialized doctors you would typically find in a listing of ear, nose and throat specialists. Not all ENTs, however, are qualified to properly interpret the results of an ENG, especially if the underlying cause of the vertigo, dizziness or nausea, is trauma. As said in the American Academy of Neurology's Practice Parameter on the Use of ENG:

"The usefulness of electronystagmography testing is highly dependent upon both test administration and test interpretation. At this time, there is no agency that governs credentials for persons who administer electronystagmography testing. Such individuals are often professionals with training in allied fields, such as audiology, but also include persons with little, if any technical background."

Understanding Subtle Brain Injury

The concussions that disable, are almost always more symptomatic at 24 hours, than at the 2-4 hour time frame when injured persons are evaluated in the emergency room. Brain injury symptoms escalate over the first 24 hours, because brain injury involves a cascade of events. It is critical that if you are still symptomatic the day after your injury, go back to the same Emergency Room, don’t wait for a doctors appointment. It is critical that the Emergency Room personnel see that the symptoms still persist or have gotten worse.

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